Project Leadership Award Nomination Form 2011 · Project Leadership Awards Nomination Form Construction Owners Association of America, Inc. 1-800-994-2622 PROJECT LEADERSHIP AWARDS

___________________________________________________________________________________________________________ Project Leadership Awards Nomination Form

Construction Owners Association of America, Inc.

1-800-994-2622 www.coaa.org

PROJECT LEADERSHIP AWARDS

NOMINATION FORM

Mail six (6) copies of the submittal and one (1) DVD/CD with the photos to COAA®, Attn: Project Leadership Awards Committee, 2859 Paces Ferry Road, SE, Suite 445, Atlanta, GA 30339, no later than August 31, 2011. Please include entry fees for each nomination submitted. Do not fax nominations. SECTION I - GENERAL PROJECT INFORMATION:

Name of Project: The George Washington University Hospital- Surgery Expansion Phase 1 Location of Project: Washington, D.C. Name and Address of Owner: UHS of Delaware, Inc 367 South Gulph Road King of Prussia, Pennsylvania 19406 Name and Address of Design Professional(s): Architect HKS, Inc 1919 McKinney Avenue Dallas, Texas 75201 MEP Engineer CCRD Partners 3625 North Hall Street, Suite 1300 Dallas, Texas 75219 Name and Address of Construction Professional(s): General Contractor HITT Contracting, Inc 2900 Fairview Park Drive Falls Church, Virginia 22042



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Electrical Contractor Power Solutions, LLC 1720 Melford Boulevard Bowie, Maryland 20715 Mechanical & Plumbing Contractor Dominion Mechanical Contractors, Inc. 12329 Braddock Road Fairfax, VA 22030 Other Consultants or Professionals: Type of Project: (Commercial, Institutional, Industrial, Governmental, Medical, etc.)

Medical

Delivery Method: (Design Bid Build, CM Agency, CM at-Risk, Design Build, Multiple Prime, etc.)

Lean/ Integrated Project Delivery Model with IFoA Contract

General Project Description:

(Provide a brief narrative of the project scope of work, not to exceed one (1) page.)

The new George Washington University Hospital was opened on August 23, 2002. The hospital had 13 operating rooms and 39 PACU beds, which served as the recovery site for patients requiring anesthesia or conscious sedation. They also serve as patient preparation beds. The hospital had seen a consistent increase in surgical volume across the last five years. As a result of existing OR capacity issues and anticipated growth in physician demand, it was essential for GW Hospital to create additional space in their surgical services department. The business plan outlined the need for the addition of two operating rooms, expanding surgical suites from 13 to 15 and addition of 13 PACU beds which would continue to serve as post-operative care units and pre/post-operative treatment bays to support the increased surgical volume. The Final Renovated area included 2 New Operating Rooms, which brought the hospital Total to 15 and 19 New Prep/Recovery Beds, bringing the hospital Total to 60. This would be a 45% Increase in Prep/Recovery Beds and 18,000 Renovated Square Foot. This renovation was to occur on the second floor of the current George Washington University Hospital which contains the surgery, cath, 12 bed ICU and endoscopy departments. There could be no interruptions of current services, no shut down of services and the added scope of two OR’s and 19 PACU had to be constructed without adding square footage to the existing hospital.



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Project Duration: (Calendar Days)

Total Project: 720 days Construction: 408 days

Project Start Date: Design: February 25, 2009 Construction: January 4, 2010

Project Completion Date: Planned Completion Date was April 18, 2011 Actual Completion Date was February 15, 2011 Changes in Schedule: Because of the structure of the team, and the exploratory work done during design, phases originally in the schedule were eliminated. Because of the focus of the team on not stopping work or affecting the operations of the existing facility the schedule could be maintained and improved. Read more in other sections. Initial Construction Cost ($): Construction $5,201,629 Final Construction Cost ($): Construction $4,365,000 Percent of Change Orders: 2% of Construction Cost



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SECTION II - OVERALL PROJECT MANAGEMENT: (Entire section should not exceed four (4) pages.)

Project Management:

(Provide two (2) examples which demonstrate project management excellence by the Owner’s Project Manager.)

Universal Health Services Inc recognizes that in order to have a successful project they have to have buy in from all team members from the staff who cares for patients or sweeps the floors to the design team to each constructor who contributes to every part and piece that goes into the project. That buy in starts by developing Conditions of Satisfaction for the project. This value initiative is formed with all players, and all players are responsible for the outcome. Every decision, every line drawn, every wall built, has to add value to the project and the Conditions of Satisfaction (COS). The COS for the George Washington University Hospital were:

• No Unscheduled Disruptions This meant disruptions to staff work flow, patient experience, patient care.

• Total Project Transparency Between all players, open budget book, open documents, at all times for

all people, including UHS.

• Stakeholder Involvement Every person whether they were in a C-Suite or Nurse on the floor, their

input was valuable.

• No Stopping of Work Building next to operational space can be difficult to do without shut

downs when there are critical patients, the team tried to prepare and plan for

avoiding the issue.

• No RFI’s Effective, transparent, no waste communication on the team was

important

• No Change Orders Change as a result of surprises or errors was not acceptable.

• Incorporate Emergency Cooling into scope This was not included in original scope, but was a high priority for adding

value to the project.

• No Rework Rework is waste.

Education for the team was important to UHS, taking the time for the team to build the foundation of trust and transparency was important to UHS. Honest discussions about our process and continual improvement of the process on a daily, weekly, and monthly basis was very important as well. Innovation ideas were encouraged and rewarded by UHS by listening to all ideas and by the incentive of a bonus sharing pool for the project. Team members could submit ideas to save time, reduce cost, or improve value on the



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project in terms of the COS for consideration. Those that had impact on the project were allowed to contribute to the bonus pool for the project. Scheduling: (Provide two (2) examples which demonstrate the Owner’s expertise in managing the schedule;

that is, identify some steps taken by the Owner which contributed to the management of the schedule.)

UHS used the pull planning to develop the schedule with a team approach. The philosophy of pull planning is that projects are networks of commitments from one team member to another. The milestones are decided first. The milestones are the cornerstone of the project, if the team can meet these, they will be successful with the overall schedule. Tasks are refined from the milestones and the tasks are performed only at the request of a customer. There are more customers on any project than just the client, if you deliver information to another party, they are your customer. Only the performer, the person doing the work, makes the promise to complete a task. Every action has a deadline, you are requested to not make a promise you cannot commit to. The tasks are transformed to an action item list, or Daily Check in List, and the team focuses on the commitments they made to each other on that list. If someone did not meet their commitment, the issue was dealt with immediately, by finding the root cause of not meeting this deadline and evaluating if the rest of the team could help with the constraint. If the team could stay current with their tasks and meet the early set milestones, the project schedule would be a success. Transparency and a sense of teamwork toward a common goal kept the schedule on track. The daily schedule was translated into a schedule matrix. On a complicated and sensitive project, where people who are having life sustaining issues inches from potential construction the transparency of the team and communication with the staff was essential. The matrix schedule was an easy to read schedule which informed all of what work was to be done where on any given day. The work was visible in a graphic form and was informative to patients, staff, and workers of what work should be and could be done where on any given day.



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Cost Management: (Describe what action the owner took with the project team to manage the project costs.)

UHS introduced Target Value Design to the team. This is a process that allows the team to design to an approved budget. It makes the team both aware of the total project budget, including fees and owner costs not usually shared, and made the team accountable to the total project budget with complete transparency. This disclosure and accountability allowed the team to strategize cost savings that would either eliminate costs or allow the team to strategically add value to the project without danger of hidden costs. They could strategize across normal project boundaries, saving money in construction to offset owner’s costs or saving money on owner’s cost to offset construction costs. The estimation was done real time with the design and coordination was done prior to construction including a team evaluation of existing conditions to prevent hidden costs often associated with renovation projects. The investigation and involvement of the team including designers, constructors, end users, trade contractors enabled the team to strategize the phasing and keep operations functioning during construction. This also enabled the user groups to make value decisions between space, finishes, equipment, and extras during the design process. The method of TVD allows value to be added into a project because of cost savings and smart decisions instead of value being taken out because of cost overruns and uninformed decisions. During the project value adds included the emergency cooling system which was part of the COS.

Quality Management: (Provide a brief narrative describing the methods of quality control/quality assurance and the

Owner’s participation in this area.)

At the start of the project the team developed a "No Punch List" process as one of the COS. The goal of the "No Punch List" was not to sacrifice quality, or prevent the design team from reviewing the work, but to increase the quality of work as well as reduce the risk of rework. The entire team, including UHS collaborated on a weekly basis and discussed work that would be occurring over the next few weeks. During these collaboration sessions, questions were answered and problems were resolved prior to work beginning. The entire team also established quality standards that were accepted by all team members prior to work activities beginning. Mock Ups, above ceiling check lists, below ceiling check lists, and the Last Planner system were some of the instruments used to control quality and limit rework. Through commitment from the GWUH team and the process that was implemented, they achieved their goal of a "No Punch List" project. The inspection for Substantial Completion at the end of each phase was completed in less than one hour with no deficiencies issued to HITT Contracting, Inc.



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SECTION III - OVERALL PROJECT SUCCESS: (Identify and briefly explain the factors that contributed to the success of the project such as the selection of the A/E, Prime Contractor and Subcontractors, approach to decision-making, handling end user requests, etc. Entire section should not exceed two (2) pages.)

Universal Health Services Inc began by selecting HKS, Inc and ccrd partners of Dallas as the lead architect and MEP designers. Both worked on the original hospital, and had previous lean training with UHS on another project. Because of the experience and training they were able to kick start some of the process improvement exercises UHS uses on their projects. The next step was to select a prime contractor and several were interviewed and UHS selected HITT because of their willingness to work as a collaborative team and learn new ways to work on a project. Subcontractors were selected based on their work attitude and their ability to be team members who contribute to the design effort, the Mechanical Plumbing trade contractor selected was Dominion Mechanical Contractors and electrical was Power Solutions. This was the core team for the design and construction of the project. To introduce the project team to the Lean Construction process and Integrated Project Delivery, several of the initial team meetings were conducted with the assistance of Lean Project Consulting to facilitate forming a Construction Lean Team. At the conclusion of the initial normal training meetings, key project team members formed the 'Lean Management Group' signing a formal Charter. The Lean Management Group met regularly to discuss progress and improvements on implementing lean principles throughout the construction efforts at GWUH. One of the key tools implemented through the lean process is developing the 'Pull Plan' and 'Work Register' through the last planner system. The pull plan develops project task commitments by working backwards from the target end date. By pulling activities and needs (and their durations) from the end date, tasks are planned based on the 'last responsible date' of completion. Tasks developed on the pull plan are transferred to the work register which provides a method of tracking and updating team members on task completion progress and identifying constraints which need to be cleared. On the surgery project, work register check-ins - 15 minute conference calls to update team members; occurred bi weekly or weekly depending on level of activity.

The team recognized that overall project success was based largely on communication with the end users of the facility. If value and quality is determined by the people occupying the space, it is important for them to define that value. It was also important for them to communicate effectively with the team what that value was. Understanding that many of the participants had never laid eyes on a set of plans, and now had to improve them, the team looked at different ways to communicate. Instead of reviewing headwall devices with end users on traditional 2-D CAD Plans or Elevation drawings, the design team used an available space in the hospital to create a quickly adjustable mock-up of a patient bed

headwall. Using velcro strips and dummy headwall devices, this allowed the users to experience



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the location and quantities of devices first hand, and most importantly provide input and make adjustments.

This hands on involvement did not stop at sign off of plans. Users were invited back to the spaces when initial construction started. With hard hats on, they were able to move back boxes and slightly adjust heights of blocking for equipment to make sure the rooms would work as necessary. This allowed them to have buy in on the space, but most importantly, it made those slight changes no cost when they would have delayed the schedule and caused change orders if done at substantial completion. It was the philosophy of the project management for the project that the end users of the space needed to have ownership and buy in, and the team was responsible to make sure they understood what they were buying into. This shift in approach provided a successful product and smooth transition into operation, and these were simple things that were done at no or very low cost. When issues arose on the project the team stopped work to address them. A Kaizen approach to learning and problem solving was implemented from the first design sketches to the construction of the project. At key points during the project formal Kaizen events took place to determine progress, but at every meeting the positive elements of the meeting were discussed as well as the things that needed to change. This could be from how the meeting was organized or how work was going on the jobsite to the temperature of the room or time the meeting took place. When conflicts came up, it was the responsibility of the team to address them. Any person who touched the problem; whether they owned the issue, or were affected by the issue was allowed to have input. The result was solutions with the best value to the owner without compromising or constraining other team members. Issues that needed to go to a “higher power” for resolution would be addressed by the Lean Management group that was led by UHS.



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SECTION IV – PROJECT COMPLEXITY: (Provide a brief narrative (i) in bullet form and (ii) maximum of one page; describing the complexity of the project including challenges, constraints and the solutions.)

Complexities of the GWUH OR project. Existing Conditions

• Major ductwork in place could not be relocated

• Flat slab construction with conduit in the slab

• Major shaft penetrations could not be relocated or increased in size. Operational Constraints

• Surgery Suite could not be shut down during construction

• ICU unit could not be shut down during construction

• Endoscopy suite could not be shut down during construction

• Must maintain both health department and Life Safety requirements during construction.

• Hospital caters to many political VIP’s because of its location Design Constraints

• Could not add square footage to urban site.

• Could not go over established budget

• Needed to incorporate state of the art technology in new OR’s

• Needed to change to decentralized nursing concept from originally designed Solutions

• Full team “Gembas” (on site surveys) of above ceiling information

• Design Team “Gembas” to evaluate space allocated and used and if it could be captured in another way, reused for another function, ore redesigned to be more efficient.

• Full team coordination throughout design to minimize affect on existing HVAC system

• Full team coordination on budget issues to capture best value for the client and keep the value coming into the project.

• Sound Demonstrations to Staff to prepare them for construction

• Matrix schedules and daily updates with staff to inform them of construction work happening every day

• Constant communication with staff to inform the construction team of critical patients or surgeries requiring special care

• Shut down plan for afterhours connections was communicated and reviewed with staff.

• Plan for transition and operation of unit was reviewed with staff for occupancy in phases.

• Design team worked with equipment experts to strategize best technology for the constrained space, but providing most effective use for a teaching hospital.



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SECTION V – SUSTAINABILITY ELEMENTS/EFFORTS: (Provide a brief narrative (i) in bullet form and (ii) maximum of one page; describing sustainability elements/efforts, if any.)

This project set out with a “do no harm” philosophy and implemented a plan to reduce waste on the job site and reuse as much original material as possible. There were no initial goals for sustainability set, but all team members, with encouragement of the owner strived to reduce the amount of paper produced on the project, eliminate any unnecessary documentation, UHS encouraged all submittals, invoices, and reports to be electronic, and all site materials removed were recycled if possible.

SECTION VI – CONFLICT RESOLUTION: (Provide a brief narrative (i) in bullet form and (ii) maximum of one page, describing the owner’s role in minimizing and resolving conflicts.)

Design Conflicts • The right people in the room at the right

time

• Transparency of information enables the best decision

• TVD informs the team of budget constraints early

Construction Conflicts

• No Blame Environment

• Five Whys to get at the Root Cause of a Problem

• Document solutions so we all learn from them and problem does not happen again

• Use Kaizen to document the change to correct a problem or just change for the better.



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SECTION VII - CUSTOMER SATISFACTION: Please attach to the Nomination Form the following letters of recommendation: 1. A letter from the Design Professional describing how they found the Owner contributed to the project success. 2. A letter from the Construction Professional describing how they found the Owner contributed to the project success. 3. A letter from the customer or end user of the facility describing their overall satisfaction with the building/facility. AFFIRMATION: Nomination is submitted by: ___________________________________ Name: ___________________________________ Company: ___________________________________ Street Address: ___________________________________ City, State/Province, Zip/Postal Code: ___________________________________ Phone Number: ___________________________________ Email Address: ___________________________________ In submitting this application, I affirm to the best of my knowledge, that the information contained herein is accurate and correct. I also agree to grant permission for COAA® to use the nomination materials in their entirety (including photographs) for promotional purposes which may include, but not be limited to, the COAA® website and the Owners

Perspective Magazine. SIGNATURE ____________________________________ DATE_________________ TITLE : ___________________________________

Documents

Project Leadership Award Nomination Form 2011 · Project Leadership Awards Nomination Form Construction Owners Association of America, Inc. 1-800-994-2622 PROJECT LEADERSHIP AWARDS